Risk of mishaps during intrahospital transport of critically ill patients

##plugins.themes.academic_pro.article.main##

Zied Hajjej
Hedi Gharsallah
Ines Boussaidi
Mayssa Daiki
Iheb Labbene
Mustapha Ferjani

Abstract

SUMMARY
Background: Mishaps are common during transport and may have major impacts on patients.
Aims: The main objectives of our study are: first to determine the incidence of complications during intra hospital transports (IHT) of critically ill patients, and second, to determine their risk factors.
Methods: All intra hospital transports for diagnostic and therapeutic purposes of patients consecutively admitted in an 18-bed medical surgical intensive care unit in an university hospital, have been studied prospectively during a period of six months (September 1st 2012 to February 28th 2013).
Results: Of 184 transports observed (164 patients), 85 (46.2%) were associated with mishaps. Eighty two mishaps were patient-related (44.5%).Oxygen desaturation (30 cases), agitation (24 cases) and hemodynamic instability (15 cases) were predominantly. One case of cardiac arrest and 3 cases of accidental extubation were occurred during IHT. Seventy three systems-based mishaps were noted (39.6%). Emergency transports, mechanical ventilation and positive end-expiratory pressure (PEEP) ≥ 6 cmH2O were independent risk factors for a higher rate of mishaps. In our study, complications did not statistically increase ventilator-associated pneumonia.
Conclusion: This study confirms that IHT of critically-ill patients still involves considerable risks and mishaps incidence remains high.

Keywords:

Intra hospital transport; Mishaps; Incidence; Mechanical ventilation; Critical care; Risk factors

##plugins.themes.academic_pro.article.details##

References

  1. Marques A. Avoiding harm during intra- and inter-hospital transport. In Patient Safety and Quality of Care in Intensive Care Medecine. Edited by Chiche JD, Moreno R, Putensen C, Rhodes A, Chiche JD, Moreno R, Putensen C, Rhodes A. Berlin: MedizinischWissenschaftlicheVerlagsgesellschaft2009:405-418.
  2. Quenot JP, Milési C, Cravoisy A, Capellier G, Mimoz O, Fourcade O.Intrahospital transport of criticallyill patients (excludingnewborns) recommendations of the Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU).Ann Intensive Care 2012 ;2:1.
  3. Australasian College for Emergency Medicine, Australian and New Zealand College of Anaesthetists; Joint Faculty of Intensive Care Medicine. Minimum standards for intrahospital transport of critically ill patients. Emerg Med (Fremantle) 2003; 15:202-204
  4. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care 2010 ;14: R87.
  5. WaydhasC. Intrahospital transport of critically ill patients. Crit Care Med1999; 3:83-89.
  6. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian incident monitoring study in intensive care. Intensive Care Med 2004;30:1579-1585.
  7. Lahner D, Nikolic A, Marhofer P, Koinig H, Germann P, WeinstablC.Incidence of complications in intrahospital transport of critically ill patients-experience in an Austrian university hospital. Wien Klinochenschr 2007 ;119:412-416.
  8. Kue R, Brown P, Ness C, ScheulenJ .Adverse clinical events during intrahospital transport by a specialized team: a preliminary report. Am J Crit Care 2011;20:153-161.
  9. Warren J, Fromm RE , Orr RA, Rotello LC, Horst HM.Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004;32: 256-262
  10. Damm C, Vandelet P, Petit J, Richard JC, Veber B, BonmarchandG .Complications during the intrahospital transport in critically ill patients Ann Fr AnesthReanim 2005;24:24-30.
  11. Smith I, Fleming S, CernaianuA . Mishaps during transport from the intensive care unit. Crit Care Med1990;18:278-281.
  12. Lovell MA, Mudaliar MY, KlinebergPL.Intrahospital transport of critically ill patients: complications and difficulties.Anaesth Intensive Care 2001;29:400-405.
  13. Decrucq EP, Julien P, Raphaël F, Saad N, Thierry O,Guerry MJ. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Annals of Intensive Care 2013;3:10.
  14. Needham DM, Sinopoli DJ, Thompson DA, Holzmueller CG, Dorman T, Lubomski LH .A system factors analysis of “line, tube, and drain” incidents in the intensive care unit. Crit Care Med2005;33:1701-1707.
  15. Papson JPN, Russell KL, Taylor DM .Unexpected events during the intrahospital transport of critically ill patients. AcadEmerg Med2007; 14:574-577.
  16. Runcie CJ, Reeve WR, Wallace PGM. Preparation of the critically ill for interhospital transfer. Anaesthesia1992 ;47: 327-331.
  17. Gillman L, Leslie G, Williams T, Fawcett K, Bell R, McGibbonV.Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit. Emerg Med J2006; 23:858-861
  18. Doring BL, Kerr ME, Lovasik DA, Thayer T.Factors that contribute to complications during intrahospital transport of the critically ill. J NeurosciNurs 1999; 31:80-86.
  19. Bercault N, Wolf M, Runge I, Fleury J-C, BoulainT. Intrahospital transport of critically ill ventilated patients: a risk factor for ventilator-associated pneumonia-a matched cohort study. Crit Care Med2005; 33:2471-2478.
  20. Fan E, MacDonald RD, Adhikari NKJ, Scales DC, Wax RS, Stewart TE .Outcomes of interfacility critical care adult patient transport: a systematic review. Crit Care2006; 10 :R6.
  21. Voigt LP, Pastores SM, Raoof ND, Thaler HT, Halpern NA . Review of a large clinical series: intrahospital transport of critically ill patients: outcomes, timing, and patterns. Intensive Care Med2009; 24:108-115.
  22. Link J, Krause H, Wagner W .Intrahospital transport of critically ill patients. Crit Care Med1990; 18:1427-1429.